Quality is never an accident; it is always the result of an intelligent effort. John Ruskin, English essayist (1819-1900)

Cardiovascular disease is the leading cause of morbidity and mortality in the United States. During the past 30 years, a stream of effective medications and counseling interventions have been developed to reduce cardiovascular morbidity and mortality. Professional organizations such as the American Heart Association and National Cholesterol Education Program have developed guidelines to integrate evidence-based care into day-to-day clinical practice. Despite widespread dissemination of the various guidelines, a significant number of patients with cardiovascular disease are recipients of suboptimal care.1